Premature Ovarian Failure

Premature ovarian failure is defined as the cessation of menstrual periods before the age of 40. It occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. The average age of onset is 27 years. A family history of POF is found in about 4% of the women experiencing the condition. Premature Ovarian Failure may occur abruptly over one to two months or gradually over several years.

POF is not the same as a natural menopause, in that the dysfunction of the ovaries, loss of eggs, or removal of the ovaries at a young age is not a normal physiological occurrence. Hormonally, POF is defined by abnormally low levels of oestrogen and high levels of FSH which demonstrate that the ovaries are no longer responding to circulating FSH by producing estrogen and developing fertile eggs. The ovaries will likely appear shriveled.

Aetiology

The cause of POF is usually idiopathic, however other causes include:

·  Genetic disorders

·  Autoimmune diseases

·  Tuberculosis of the genital tract

·  Smoking

·  Radiation and/or chemotherapy

·  Ovarian failure following hysterectomy

·  Prolonged GnRH (Gonadatrophin Releasing Hormone) therapy

·  Enzyme defects

·  Resistant ovary

·  Induction of multiple ovulation in infertility

Diagnosis

  • History and physical examination
  • Chromosome study (karyotype)
  • FBC, TFTs, PTH
  • Ovarian antibodies test (if available)
  • Serum LH and FSH and oestradiol values in the follicular phase of the cycle (at least two samples should be performed to rule out intermittent ovarian failure and to confirm the diagnosis).

Treatment

Unfortunately, there is no proven method of stimulating the ovaries if POF is diagnosed. Infertility results & osteoporosis or decreased bone density affects almost all women with POF due to an insufficiency of oestrogen. There is also an increased risk of heart disease, hypothyroidism in the form of Hashimoto's thyroiditis, Addison's disease, and other auto-immune disorders.

All women should be prescribed COP or HRT until 50y and should have 3 yearly DEXA scans.

  • A short course of oestrogen replacement therapy may lower the FSH to an acceptable value before attempting ovulation induction with human menopausal gonadotropins. With the new in vitro fertilization technologies using donor eggs, pregnancy has been achieved in women with premature ovarian failure who until recently had no hope for conception.

Refer patients to

https://patient.info/health/premature-ovarian-insufficiency-leaflet